The opioid antagonist naltrexone (brand names: ReVia, Vivitrol, and Depade) is approved to treat those who abuse opioid medications or alcohol.
The drug comes in a pill form (Depade and the more popular version ReVia) and as an extended-release injectable form (Vivitrol). Naltrexone is designed to reduce and suppress cravings for alcohol or opiate drugs. It does this by binding to the opioid receptors in the person’s brain (thereby removing any opiate drugs on these receptors) and suppressing cravings.
Naltrexone is considered to have no abuse potential and does not result in the development of physical dependence. An individual must obtain a prescription in order to legally obtain it, and the medication is typically used in situations where individuals are actively recovering from alcohol use disorders or opiate abuse.
Naltrexone does not treat withdrawal symptoms; rather, it is designed to suppress cravings for alcohol or opiate drugs. Individuals with moderate to severe alcohol use disorders who are using naltrexone may experience withdrawal symptoms if they stop drinking that can be potentially fatal due to the development of seizures. These individuals should consult with an addiction medicine physician or psychiatrist before discontinuing their use of alcohol.
Research FindingsThe standard method of using naltrexone is for individuals in recovery from alcohol use disorders or opiate use disorders to take the medication in the morning while trying to remain abstinent from these drugs. Research findings are mixed, but overall, they tend to support the notion that individuals who use naltrexone to treat alcohol abuse reduce the total amount of alcohol they consume and observe a reduction in the number of times they drink alcohol. In addition, heavy drinkers often notice significant reductions in alcohol use. However, the research does not indicate that the use of naltrexone is effective at assisting individuals in remaining totally abstinent, but it does most likely result in a significant reduction in cravings for alcohol and an overall reduction in the amount of alcohol consumed.
Like any drug, naltrexone can only work if an individual uses it, and there is evidence to suggest that issues with compliance often reduce its effectiveness.
Research findings do not suggest that naltrexone is a panacea, but that its use should be accompanied by formal substance use disorder treatment (most often, some form of substance use disorder therapy).
- Nausea, stomach cramps, and diarrhea are the most common reported side effects; however, these typically resolve over time.
- Some individuals may experience muscle stiffness, cramps, and headaches.
- Sleep disruptions (including both insomnia and hypersomnia), anxiety, and dizziness have also been reported.
- Individuals should not use opiate drugs while taking naltrexone. People who use opiate drugs and take naltrexone may experience opioid withdrawal symptoms as naltrexone is an opioid antagonist. The Food and Drug Administration (FDA) recommends that individuals who use naltrexone should be abstinent from opioid drugs for a week to 10 days. Because naltrexone is an opioid antagonist, people using it and who also use opioid medications for their psychoactive effects will not experience the typical “high” that they get from opiate drugs. This may result in individuals taking more opiate drugs than they normally would and potentially overdosing on opiates.
- Pregnant women should not use naltrexone.
Drinking Alcohol while Taking NaltrexoneThere appear to be no significant dangers associated with taking naltrexone and drinking alcohol. Information provided by the FDA and by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) report that individuals who drink alcohol and use naltrexone:
- Will still experience the functional impairments that are associated with alcohol use, such as a loss of motor coordination, decreased response time, problems with slowed rates of thinking, etc.
- May experience less of an urge to drink more alcohol
- May reduce their alcohol intake
Thus, research supports the notion that naltrexone is effective in reducing alcohol intake but not effective in promoting abstinence from alcohol. Individuals in these studies often continued to drink alcohol while on naltrexone, and there were no significant or dangerous effects noted. In fact, one method of treating alcohol use disorders known as the Sinclair Method suggests that individuals take naltrexone about one hour before they begin drinking alcohol. At least one research study has suggested that taking naltrexone in this manner (only taking the drug one hour before one is planning to drink alcohol) results in a significant reduction in alcohol cravings and intake compared to the suggested use of naltrexone, which is to take it in the morning and attempt to remain abstinent from alcohol. The developer of this method, Dr. Sinclair, reported that using naltrexone before drinking alcohol in this manner is significantly more effective in reducing alcohol intake than using naltrexone as an attempt to help the person become or remain abstinent from alcohol. These research reports still need further investigation and replication.
- Result in a person becoming significantly more or less intoxicated based on the amount of alcohol they have drank
- Cause the person to become violently ill in the same way that Antabuse (disulfiram) does
- Reduce the short-term effects of alcohol use/abuse (unless the individual drinks less alcohol as a result of using naltrexone)
- Reduce any long-term effects associated with chronic alcohol abuse, including liver damage, cardiovascular damage, kidney damage, an increased potential to develop cancer, and an increased potential to develop neurological issues, such as stroke, seizures, or even dementia (unless the use of naltrexone results in the individual drinking significantly less alcohol over time)
- >Reduce any cognitive issues associated with becoming intoxicated, such as issues with judgment, memory, mood swings, etc. (unless the person’s use of naltrexone results in them drinking significantly less alcohol)